Abstract

The aim of this thesis is to explore pregnancy and perinatal outcomes in diagnosed
HIV-infected women receiving antiretroviral therapy (ART) in the UK (United
Kingdom) and Ireland. Population-based surveillance data on HIV-infected pregnant
women and their children is collected through the National Study of HIV in
Pregnancy and Childhood (NSHPC), which includes information on over 8000
pregnancies delivered between 1990 and 2007. The majority of diagnosed infected
women now take highly active antiretroviral therapy (HAART) in pregnancy, which
reduces the risk of mother-to-child HIV transmission. However, there have been
concerns over the potential for maternal and fetal adverse effects, with conflicting
findings from European and American studies regarding the association between
HAART and premature delivery.
In this thesis, trends over time in the demographic characteristics of HIV-infected
pregnant women in the UK and Ireland are described, along with changes in the
uptake of interventions for preventing mother-to-child transmission. Transmission
rates are explored over a period when HAART was routinely available, and
subgroups of women managed in the context of regularly updated national guidelines
are compared with respect to their risk of transmission. Multivariable logistic
regression models are used to assess the association between type of ART exposure
in pregnancy and adverse outcomes including pre-eclampsia, prematurity, stillbirth,
neonatal death and congenital abnormality. In addition, using data from the European
Collaborative Study and the Pediatric Spectrum of HIV Disease project alongside the
UK and Ireland data, the effects of differences in populations and methodologies
(study design and analytical approach) on the observed association between HAART
and premature delivery are investigated, and a pooled analysis of individual motherchild
pairs is carried out. Finally, the risks and benefits of ART in terms of adverse
pregnancy outcomes and mother-to-child transmission were jointly modelled using
Monte Carlo simulation methods, to produce a risk-benefit ratio.

Type:

Thesis (Doctoral)

Title:

Antiretroviral therapy and pregnancy outcome in HIV-infected women in the United Kingdom and Ireland